a medical librarian's adventures in evidence-based living

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If you received this post via email, click here to get to the web version with all the links & Dr. Barnard's video.

This is hands down, one of the best videos I've seen to explain how what we eat affects our health & our weight. Whether you're pre-diabetic, already have type-2 diabetes, or you're perfectly healthy--take the 37 minutes to watch this.

Just watch it until the end. And he even changed my mind about salmon.

Highlights from the Healthy Librarian's Notes

I didn't watch this with the intent of posting about it (beyond Facebook)--so I took quick notes. But I learned so much from the video, I couldn't resist posting my notes here.

Here's what captured my attention. Please watch the video for yourself, though--don't just rely on my notes-you'll miss a lot!

Please Note: The video is about Type-2 Diabetes, not Type-1 Diabetes, aka Juvenile Diabetes. They are different diseases.

1. Sure, diabetes means you have too much glucose. But, glucose is good thing. It's not the bad guy. It powers our muscles. It powers our brain. We need glucose.

2. The problem with glucose & diabetes, is that it's not going where it's supposed to go--into the cells that need the glucose--it's circulating around in the blood. And when there's too much glucose circulating in the blood, it can damage our blood vessels--especially the tiny ones--like behind our eyes, in our kidneys, and in our feet--as well as our heart. Diabetes is the leading cause of blindness, kidney, and heart disease.

3. Carbohydrates are not the cause, and have never been the cause of diabetes. If that were the case, then cultures that eat a diet made up of mostly high-fiber whole food carbohydrates would have high rates of diabetes. That's not the case. And when people from these cultures move to a Western country & start eating as we do--their rates of diabetes rise.

6. Why do people lose weight on a vegan no-added oil diet--yet still feel full & satisfied? Simple mathematics. Every gram of fat has 9 calories. Every gram of carbohydrates has 4 calories. If you take fat out of the diet, you lose weight. Note: We're talking about whole grain, high fiber, unprocessed carbohydrates--not white flour or Entemann's Fat-Free Cookies.

7. The Fiber Connection to weight loss--the Fullness Factor: The average American eats about 12 grams of fiber a day and consumes about 2000 calories a day. As soon as you increase your fiber intake with fruits, vegetables, beans, & whole grains--the average person is able to feel full on 200 calories less--1800 calories. Blame that on the fiber.

8. A vegan high-fiber diet has a higher "thermogenic effect" on our metabolism, than the typical Western diet. Huh? Let me try to explain. (But Neal does a better job.) Prior to starting a vegan diet, Barnard measures the oxygen intake of his patients. Turns out, if you're taking in a lot of oxygen, you have a fast metabolism, & burn calories faster. The less oxygen you take in--the slower your metabolism, & the slower the calorie burn. His patients who are eating the typical Western diet are taking in less oxygen--and have slower metabolisms. Yes, what you eat affects the speed of your metabolism. Barnard measures his patients after they eat 2 cans of Boost (that awful "faux" meal in a can)--both pre-vegan diet--and post-vegan diet. After the switch to a vegan diet--his patients had on average, a 20% increase in their "after meal" calorie burn. They had kicked their metabolisms up a notch! Another weight-loss booster.

Why the increase in calorie burn on a vegan diet? The "thermic effect" of food increases on a vegan diet as compared to a Western diet, because the nutrition in the vegan meals is able to enter our cells more efficiently--providing a better calorie burn after every meal. This effect lasts for about 3 hours after each meal.

9. Dr. Barnard's NIH-funded study compared the American Dietetic Association's Diet to the vegan diet for type-2 diabetes. 99 participants. Barnard shares the example of Vance--a 31 year-old diabetic with a long family history of diabetes & diabetic complications. At the start of the study his A1c level was 9 1/2--on the high side.. The average diabetic's A1c level is 8. After going on a vegan diet, Vance's A1c level dropped to 5.3. Within a year he had lost 60 pounds, and his doctor said there was no longer any reason for him to stay on diabetes medications.

10. How Food Can Fight Pain. Barnard shares an example of a diabetic study participant who also had rheumatoid arthritis. After changing to a vegan diet she discovered that she was able to easily open up cans--an impossible task beforehand. According to Barnard, about 1/2 of arthritis sufferers have an identifiable food connection to their disease. It's not 100% for everyone--but, for about half of rheumatoid arthritis sufferers, eliminating dairy & animal protein relieves their pain.

11. "Can I have a little salmon every once in awhile?" Short answer from Barnard? No! Sure it has some good fat--the omega-3s--but it also has some bad fat. All fish is a mixture of good fat and bad fat--and the waistline can store good fat just as well as it can store bad fat. Chinook salmon is 50% fat! I checked--and believe it or not--Barnard's right!

12. What about white meat? Chicken? Turkey? The leanest beef is 29% fat. Chicken is 23% fat. Beans are 4% fat. You run the numbers. According to Barnard, you can't reverse diabetes by going from beef to chicken. Gee, how many people do we all know who think that switching from beef to chicken is the healthy choice? I know I did.

13. If you go on a vegan diet, play it safe & take a multi-vitamin & B-12. (OK--I know there's some controversy about taking multi's, but Barnard is playing it safe.) Vegans need adequate B-12--and there aren't reliable sources of it in the plant world. Taking a B-12 is a very easy fix. You'll already be getting far more of the vitamins & minerals you need by switching to a vegan diet. B-12 is the exception. Eat flax meal or chia daily for omega-3.

14. Don't change your diet immediately. Take a couple of weeks to look over Barnard's meal plan, and explore healthy (no-added oil) plant-based cookbooks before you get started. Planning ahead will make a big difference to your success. You'll be armed with a game plan! Here's the link to his 21-Day Weight-Loss Kick-Start book for some inspiration. Try out some recipes. Get some good recipes under your belt. 6-8 is all you really need to get started.

What if you don't cook? What if you have the "Room-Service" Gene. Barnard has plenty of great suggestions about what to order at Italian, Mexican, fast-food, Japanese, & Indian restaurants. Here's a link to his Kick-Start site, with recipes & meal plans.

15. If you are diabetic & you change your diet--just be aware that you may become hypoglycemic, if you're taking diabetes medication. This is natural--you're blood sugar is decreasing (a good thing)--and if you're taking medication for diabetes, this can happen. He has suggestions to deal with this natural occurence--and of course actively work with your doctor. Listen to the entire video, so you don't miss Barnard's recommendations.

16. Take the Three-Week Challenge. Do it for every meal. Do it everyday. Even if you're invited to a free meal at Outback Steak House---order a plain baked potato & go to the salad bar. There are options. The only way you'll be able to see how well this diet works--and be able to feel what it's like to be on a healthy diet--is to give it 100% for three weeks. No exceptions, or rule-changing.

17. You need three weeks in order for your "tastes" to change. Barnard gives the example of switching from whole milk to skim milk. It's hard to do at first--skim milk tastes so watery. But, once you're used to it--you can't go back. That's how it is when you switch to a vegan diet--and start enjoying plant-based meals. It's hard to go back to cheeseburgers & steak. I wouldn't have believed it either, if I hadn't tried it myself.

18. And, if you find you don't like a vegan diet, you can always go back to the foods that got you sick in the first place. And stay on medications, and test your blood levels for the rest of your life.

19. If plant-based foods aren't for you--consider the transition foods. The faux meats. There are plenty of relatively low-fat options--and the flavors just keep getting better and better. Neal's own father, a former cattle rancher in Fargo, North Dakota, doesn't quite realize he's a vegan--because Neal's mom keeps preparing faux meats--for her meat-loving husband.

20. Barnard's tips: Try different recipes. Do it for 3 weeks. Eat faux if you absolutely must. Think of it as methadone.

21. Annual cost of medications for diabetics is $2000-$5000/a year--for diabetes medications & statins. Now multiply that by the 21 million diabetics in the U.S. And that's just the cost of medications--and doesn't include hospitalizations & complications. Isn't it high time to lower our health care costs?

22. Worry about our kids. Childhood obesity & diabetes are on the rise. As beef & dairy prices fall, our government helps the farmers by buying it up & feeding the surplus to our kids through the school lunch programs. Feeding our kids cheeseburgers & pepperoni pizza, in the end is not the wisest economic decision.

I apologize for these incomplete notes--and for any statements I may have inadvertently written down incorrectly.

I encourage you to watch the video yourself.

It's a 37 minute time investment you will not regret. And besides--Barnard is just plain interesting, as well as funny. It's better than anything you'll find on TV tonight!

May 31, 2010

If you've received this via email, Click here to get to the web version of this post with all the links

Before May 12, 2010, I'd never met nor had the opportunity to hear Dr.Tom Morledge speak. I only knew that he had a long-time interest in wellness and integrative medicine--and that he kept a close watch on the scientific literature to determine what's working--and what's not. Definitely, my kind of physician.

Earlier this month I had a chance to attend a Wellness Grand Rounds where Morledge spoke on, "Nutraceuticals from A-Z". Tom had so much information to fit into one hour that he was forced to speak at mach speed--and only got as far as H!

Morledge does his homework. When it comes to using nutritional supplements in medical practice, he wants to know their mechanism of action, the evidence for their efficacy, and how they might interact with other pharmaceutical drugs--as well as their potential side effects. And quality control of nutraceuticals is of prime importance to him--knowing which companies have the highest standards--because unlike drugs, vitamins & supplements are not regulated by the FDA.

Use my notes only as a spring-board for your own research--and certainly consult your own physician! I could have missed some key points. I could have misheard something. I don't have transcripts, Power Point slides, or even a recording with which to double-check my notes.

Who is Dr. Thomas Morledge? He's a board certified physician in Internal Medicine and Pediatrics--and he's certified with the American Board of Holistic Medicine. He's a clinician in the Cleveland Clinic's Center for Integrative Medicine, as well as the Medical Director for their Wellness Enterprise. He walks his talk. He's a spare-time farmer & gardener, a triathlete, with a passion for healthy cuisine, spirituality, and music. Plus, he's easy-going, incredibly knowledgeable, with a sense of humor, to boot!

Alpha-Lipoic-Acid

This is an anti-oxidant that also helps the body to recycle other anti-oxidants--definitely a good thing! It dampens damaging free-radicals, and has been successfully used to treat diabetic neuropathy. In clinical studies of its use for the treatment of diabetic neuropathy, 53% of people with diabetic peripheral neuropathy experienced improvement.

Neurontin is the standard medical treatment for diabetic neuropathy--and it comes with serious side effects. And the stats for Neurontin aren't as good as ALA--1 out of 3 patients improve.

ALA is the definite winner in this match-up. It also has low toxicity, and minimal drug interactions. There is some theoretical concern about its use in cancer patients--a situation where you don't want anti-oxidants to interfere with chemotherapy.

Bottom Line: It's an excellent anti-oxidant, with an optimal recommended dose of 300 mg/ 2-3 times a day. I'm a personal fan of Juvenon--the ALA/acetyl L-Carnitine supplement developed by Dr. Bruce Ames of UC Berkeley.

Art of Medicine

This is the concept of personalized medicine--how to figure out what's best for an individual. Morledge prefers to consult evidence-based-medical literature when it's available--but it doesn't exist for every drug, nutraceutical, or condition. The same goes for the gold standard in medicine--the randomized controlled trial. They aren't always available--and because of the high costs involved in running these trials--they're often scarce when it comes to nutraceuticals. Meta-analysis--when a researcher looks at all the clinical trials for a particular treatment or condition to determine what's working and what's not-- is an even better resource--but not often available.

Something else to consider: According to Morledge, medicine is good at figuring out mortality statistics (lives saved by a treatment)--but it isn't very good at measuring VITALITY.

One measure or marker of vitality is how much muscle mass is preserved as one ages. After age 40 we start to lose 10% of our muscle mass per decade--resulting in the physical frailty of the elderly, and loss of organ reserve. Decline often starts in the 50's & 60's--and according to Morledge, it's possible to prevent disability for 7 years--which bottom line, is the "name of the game", & more important than just extending years. Another good reason to exercise, and weight train as we age. Use it or lose it.

Another newer measure of vitality is telomere size. Telomeres are similar to the protective plastic caps on shoelaces. They protect valuable
genetic material needed for our cells to divide properly, and to repair
worn-out cells. The greater the size of the telomeres as we age, the better the chances for longevity. In fact, increased telomere size is a marker for decelerated aging. I've written often about telomeres--and it should be no surprise that exercise, diet, and omega 3's have all been shown to preserve & increase telomere size. Click here to read more.

Boswellia

This was a new one for me. It's a nutraceutical that comes from tree resin--and is well known for its anti-inflammatory properties. It's been used for asthma, Crohn's disease, and osteoarthritis.

5-Loxin is the standard nutraceutical product name for Boswellia, and that's what you want to look for.

Osteoarthritis and the knee: In a 65 person study, 250 mg of 5-Loxin showed benefit in relieving stiffness, function, and pain. Measurements of knee inflammation also decreased significantly.

5-Loxin/Boswellia is safe, with no identified drug interactions, and its anti-inflammatory benefits have been documented through biomarker measurments.

It has few reported adverse effects, and they're minor: nausea & heartburn.

Since 5-Loxin is not well-absorbed it should be taken with a fatty meal.

Dose: 250 mg/day--it comes typically in 50 & 75 mg capsules.

Bioavailability

How do we know if a nutraceutical works? How available is it to the body after it's ingested? This is a complex & difficult question. First of all, it has to go into the small intestine, and it has to be a,bsorbed.

Take the ORAC Index for example--the measure of foods by their anti-oxidant capacities. Even if a food is known to have a high anti-oxidant ranking (ORAC index) it's still difficult to know how "bioavailable" its anti-oxidants will be after the food is eaten. Are its anti-oxidants actually making their way into the bloodstream--and at what levels? We have to judge by other markers of improvement. To read more about ORAC & antioxidants, click here.

Consumer Labs

This is a recommended online resource that evaluates nutraceuticals and vitamins for their active ingredient content, safety and purity. But here's a little known fact about this group that's important to be aware of.

If Consumer Labs, acting as an independent "watch-dog agency" pulls products off the shelf to measure and analyze--you'll find the results on their website. But, if a company pays them to evaluate and analyze their product--and it gets a negative evaluation--it won't be found on their website. Something to keep in mind.

Morledge thinks that the low-cost online membership to Consumer Labs is worth the price for the assurance it provides about the content & safety of vitamins & supplements. Click here for that link.

Morledge has personally made visits to three nutriceutical companies. Two he found to be stellar--following all the proper safe manufacturing practices--while the third one he described as a "nightmare". He declined to mention the names of these companies publicly, but if you want to know which companies have passed his quality tests, take a look at Cleveland Clinic's 360 Wellness site for trustworthy manufacturers & their supplements. Click here

Vitamin C

There have been a lot of proposed benefits and uses for vitamin C over the years--but bottom line, the research hasn't lived up to the claims.

Treatment and prevention of colds: only 8% of people will reduce the duration of a cold, and only by one day by taking vitamin C--and that doesn't take into account the "placebo effect".

But...there is one proven benefit for vitamin C. Its best indication is for the prevention of colds in endurance athletes--because their extreme exercise training can suppress their immune system. Vitamin C has been shown to prevent colds in athletes only. And, not with mega-doses. The most beneficial dose has been 125-250 mg twice a day.

Vitamin C has a low toxicity profile, and it's cheap.

Vitamin D

If you live in the Northern latitudes, between October through April, ultraviolet rays are just not available, and 70-80% of people living in Northern communities are found to be deficient in vitamin D. The levels don't get much better in the summer either, because so many of us don't venture outside often enough--and when we do, we're often slathered with sunscreen.

Quick history: The original RDA for vitamin D was based solely on the amount needed to prevent rickets. As it turns out, that is a woefully low amount, 400 IUs. Today, research studies are showing that low D is associated with osteoporosis, falls in the elderly, upper respiratory infections, breast cancer, multiple sclerosis, and more.

Morledge mentioned that the obstetric and gynecologic associations have recently raised their recommended levels of vitamin D to 2000-4000 IUs/day--but I was not able to substantiate this recommendation--except for the recent NIH study completed by Drs. Bruce Hollis & Carole Wagner that I've posted about in the past. Cick here.

So, what's the optimal blood level for vitamin D, according to Morledge? Definitely a score of 30 or more on the 25-hydroxy-vitamin D test--but he says aiming for 40 is reasonable. He advised 1000 IUs as the upper limit for infants, and 2000 IUs for everyone else. To read more about vitamin D, and what the vitamin D experts recommend click here.

Drug interactions: Certain drugs may increase or decrease the absorption of vitamin D, including St. John's Wort, which has many potential interactions with drugs. Other drugs known to interfere with vitamin D absorption include: anticonvulsants, bile acid sequestrants (for cholesterol), Tagamet,
corticosteroids, and heparin.

Morledge recommends consulting the Natural Standard Index--the Authority on Integrative Medicine to check for drug interactions with any nutriceuticals. I feel fortunate that my library has this excellent resource available online--but check with your local medical or public library to see if they have access to this valuable resource. Click here

Vitamin E

There are definitely issues concerning taking vitamin E in its natural form--and its synthetic form. Some adverse effects have been associated with taking vitamin E at levels over 400 IUs--namely, increased mortality for those who are taking statins, and potential adverse effects for those with bleeding disorders or head & neck cancers.

He knows of no clinical trials that used natural mixed tocopherols (vitamin E)--most trials have used the synthetic form.

SAMe

This supplement has been successfully used for osteoarthritis pain. The journal BMC Musculoskeletal Disorders looked at how SAMe matched up against celecoxib (Celebrex) in the treatment of osteoarthritis. Click here for the article.

The researchers found that SAMe was as effective as Celebrex for improving pain relief in osteoarthritis--the only difference was that it took a few weeks longer for SAMe to work.

The added bonus: It has limited side effects--unlike other anti-inflammatories.

Downside: The cost. The SAMe dose that relieves osteoarthritis pain is 1600 mg/a day--which amounts to about $8/day--and is obviously very expensive.

SAMe and depression. Here's another use for SAMe. In reviews of the medical literature SAMe turns out to be as effective for the treatment of depression as prescription anti-depressants--and with very limited side effects. Click here for the review. Dosage is the same: 1600 mg/day

Functional Medicine

What's this? It's basically integrative medicine--looking at each person's story before deciding on a course of treatment. It's looking at an individual's level of oxidative stress, energy, fitness, stressors, sleep, support system, and diet.

We're obviously not all the same--and some of us will need more or less of some things than someone else. That might mean removing foods that we are sensitive or allergic to--or adding prebiotics. You get the idea.

Ginger

For nausea & vomiting--think ginger--and I don't mean ginger ale. It's been studied for use in a variety of settings: pre-op, obstetrics, and for motion sickness.

As for ginger, it looks like it's a good treatment for nausea & vomiting. It's inexpensive, it has limited side effects, and limited drug interactions.

Recommendations: A total of 1 gram a day--taken as 250 mg/ 4 times a day for pregnancy. My note: Definitely consult your doctor on this one--especially for pregnancy!

Glucosamine

A recent UK Health Technology Assessment Report looked at the medical literature, and the esteemed Cochrane Systematic Reviews Database to assess the benefit of glucosamine. Click here for that report.

Bottom line: Glucosamine provides a little bit of pain relief for knee pain. Its pain relief is slightly better than that of a placebo--but, and this is a big but...the placebo was 40% effective! Its toxicity level is also low. 1500 mg/day is the recommended dose.

"To market a medication (pharmaceutical drugs), all you have to do is
prove that it's better, on average, than a sugar pill. A drug that
works 20% of the time, for instance, may be considered effective--even
though it does nothing for 80% of patients."

Matched against non-steroidal anti-inflammatories--glucosamine might be the better choice, because it is safer, and has less side effects than NSAIDS.

It has a half-life of 16 hours, which means you can take it once a day and still get relief.

How does it work? Glucosamine is absorbed into the cartilage and it helps repair the cartilage, as well as decreasing cartilage degradation.

Hot Flashes

According to the Cochrane Database for Systematic Reviews, the gold standard for systematic reviews, there is no conclusive evidence for the benefit of soy isoflavones in alleviating hot flashes. Click here for the abstract.

High doses of isoflavones seem to do a better job than low doses. And there is no evidence of adverse side effects. Here's an interesting point to consider when it comes to the soy-hot flash question. The women who were given the placebo quit right away--because there was clearly no relief for them!

Morledge says that a nutriceutical made from soy (specifically fermented daidzein), known as S-(-)Equol, is excellent for the relief of hot flashes. A dose of 3 times a day (sorry, that's all I jotted down) has shown statistically significant benefit in the relief of vasomotor (hot flashes) and somatic (physical) symptoms of menopause. Click hereto read more.

I wasn't able to find out much about this, however, a number of just published "ahead of print" articles about S-Equol have just appeared in May 2010 in the Journal of Nutrition, including, "Equol Improves Menopausal Symptoms in Japanese Women" by Takeshi Aso. In Aso's study women taking 10 mg of an S-Equol supplement experienced significant relief of their menopausal symptoms. The supplement was developed by Otsuka Pharmaceuticals.

So there you have it. Nutriceuticals from A-H. I-Z should be coming in November, 2010. Please consult your own physician before starting any supplements. This post is just a transcription of my lecture notes--and may be incomplete or misinterpreted.

I'd love to hear if anyone has any personal experience with any of these supplements--pro or con. Please let me know.